Hepatocellular carcinoma occurrence is associated with various probable causative factors. It was estimated that 75% to 80% of cases of primary liver cancers may be prevented. Therefore, individuals who are suffering from the diseases that are considered risk factors for developing hepatocellular carcinoma should undergo regular screening examination to detect the tumor as soon as possible and thus provide the best treatment and outcomes.
Various disorders are associated with the increased risk of developing hepatocellular carcinoma including:
- Cirrhosis of any cause;
- Chronic hepatitis B (especially with high level of virus replication and hepatitis D coinfection) and C;
- Chronic alcohol consumption;
- Aflatoxin B1 and other mycotoxins;
- Nonalcoholic fatty liver disease (NAFLD), or nonalcoholic steatohepatitis (NASH);
- Primary biliary cirrhosis;
- α1-antitrypsin deficiency;
- Glycogen storage diseases;
- Wilson’s disease;
- Hereditary tyrosinemia;
- Radiation exposure;
Male gender, age over 55 years, Asian and Hispanic ethnicity, family history of HCC in a first-degree relative, overweight and obesity (especially in early adulthood), tobacco use, diabetes mellitus, hypothyroidism (in women) are also associated with the increased risk of developing hepatocellular carcinoma. Some studies suggest that long-term use of oral contraceptives may also increase.
Primary preventive measures
Primary prevention of the disease implies prevention of the diseases or toxic exposures which pose the risk of developing cancer in the future.
- Mass vaccination against viral hepatitis B may reduce the incidence of HCC in the general population;
- Advances in the treatment of chronic hepatitis B and C – effective treatment of viral hepatitis is known to reduce the risk of developing HCC in the future;
- Early treatment of hereditary hemochromatosis and other congenital disorders which are known to damage the liver eventually;
- Avoiding the exposure to toxic chemicals and foods harboring molds that produce aflatoxin by checking the corns, grains, and nuts for any evidence of the molds, making sure that they are stored properly in dry storages;
- Alcohol abuse is a major risk factor for developing HCC – so probably the most important preventive measure is avoidance and treatment of alcohol and drug abuse;
- Consumption of coffee, vegetables, white meat, fish, and omega-3 polyunsaturated fatty acids; aspirin use; and statin and metformin therapy in individuals with diabetes are considered protective;
- A diverse healthy diet is helpful to maintain overall health and deactivate the aflatoxins;
Screening examination as secondary prevention
Hepatocellular carcinoma may remain asymptomatic for a long period. On the other hand, the sooner it is detected the easier the treatment is and the better the outcomes may be expected. Therefore, individuals who have any disorders which increase the risk of developing HCC should be screened for hepatic cancer regularly.
- Individuals who have chronic hepatitis B;
- Those who have a family history of hepatocellular carcinoma;
- Individuals who have cirrhosis caused by chronic hepatitis B or C, alcohol abuse or another chronic liver disease;
The risk of developing HCC in a person with cirrhosis is about 3-5% a year, in approximately 60% of cases nodules detected during the screening later confirm to be malignant.
Screening examination should include ultrasonography and alpha-fetoprotein testing performed every 6 months.